CPSS/420 V2 Angel Case Study

CPSS/420 v2 Angel Case Study CPSS/420 v2 Angel Case Study (Anxiety, PTSD, Substance Use Disorder)

The case study involves Angel, a 44-year-old man with a history of substance dependence and anxiety disorder that began in his early 20s after joining the military. His initial use of alcohol was to manage anxiety symptoms, especially during social interactions at the NCO club. His symptoms intensified after deployment to Iraq, where he experienced combat-related stress as a military police officer, often exposed to hostile fire. His substance use history includes alcohol and cocaine, which contributed to his discharge from the military under dishonorable conditions. Additionally, Angel faced legal issues related to domestic violence, which led to court-ordered treatment, community service, and probation.

Angel reports that withdrawal from cocaine and binge drinking exacerbate his mood and anxiety symptoms. Despite previous inpatient treatments and referrals to support services, he has not maintained sustained abstinence. He is currently unemployed and uninsured, with no VA benefits, adding challenges to accessing ongoing treatment. Motivated by a desire to improve his emotional health and maintain relationships, especially as he anticipates becoming a grandfather, Angel is seeking assessment and intervention for his PTSD, substance use, and anxiety disorders.

Analysis of Symptoms and Diagnoses

Angel exhibits a complex clinical picture characterized by comorbid PTSD, substance use disorder, generalized anxiety disorder, and depression. His military experience and exposure to combat have left him with PTSD symptoms, including intrusive memories, hyperarousal, and avoidance behaviors. The substance use appears both as a coping mechanism and as a factor exacerbating his mental health issues. Symptoms of depression, such as low mood and diminished motivation, are consistent with his history of substance dependence and ongoing legal, relational, and personal struggles.

Evidence-Based Treatment Approaches

PTSD

For PTSD, treatments with strong empirical support include Cognitive Processing Therapy (CPT), trauma-focused Cognitive Behavioral Therapy (cf-CBT), and Eye Movement Desensitization and Reprocessing (EMDR). CPT is particularly effective in helping individuals process traumatic memories and challenge maladaptive beliefs (Resick et al., 2017). EMDR facilitates trauma processing through targeted eye movements, reducing the emotional charge of memories (Shapiro, 2018). Both therapies aim to normalize trauma responses and improve functioning.

Substance Use Disorder

Addressing substance dependence, especially involving cocaine and alcohol, requires integrated treatment. Motivational Interviewing combined with CBT (MI-CBT), Seeking Safety, and Motivational Enhancement Therapy (MET) are empirically validated approaches (Najavits, 2015; Monti et al., 2002). Seeking Safety is particularly suitable for concurrent PTSD and substance use disorder, focusing on coping skills, safety, and stabilization. These approaches emphasize building motivation, enhancing self-efficacy, and developing healthier coping strategies.

Generalized Anxiety Disorder

CBT tailored for GAD has demonstrated efficacy in reducing anxiety symptoms (Dugas et al., 2010). Psychoeducation and mindfulness-based interventions further support symptom management by increasing awareness and acceptance of anxious feelings (Hofmann et al., 2012). These methods promote resilience and emotional regulation, essential for individuals like Angel who struggle with chronic anxiety.

Integrative Treatment Strategy

A comprehensive, individualized treatment plan for Angel would involve concurrent trauma-focused therapy for PTSD, integrated substance use interventions, and anxiety management techniques. Given his lack of insurance and ongoing legal commitments, outpatient services emphasizing affordability and accessibility are critical.

Motivational interviewing can be employed initially to enhance readiness for change, focusing on reducing ambivalence about abstinence and recovery. Subsequently, CPT or EMDR can be introduced to process traumatic memories. Simultaneously, cognitive-behavioral techniques for anxiety, including psychoeducation and mindfulness exercises, can help manage GAD symptoms (Hofmann, 2014). Support groups such as 12-Step programs or SMART Recovery can serve as adjuncts for ongoing peer support and relapse prevention.

Building a collaborative therapeutic relationship is essential, emphasizing strengths, goals, and motivation. Family involvement, where appropriate, could enhance support and accountability, especially as Angel seeks to rebuild relationships with his children and maintain his role as a future grandfather.

Barriers and Considerations

Challenges include uninsured status, lack of VA connection, legal restrictions, and ongoing legal obligations. These barriers necessitate flexible, low-cost services and community-based resources. Engagement strategies such as peer recovery coaching and mindfulness-based recovery models can foster sustained participation and empowerment. Also, addressing stigma and promoting hope are vital components in motivating continued engagement and recovery efforts (McHugh et al., 2019).

Conclusion

Angel's case underscores the importance of an integrated, trauma-informed approach to treating co-occurring PTSD, substance use disorder, and anxiety. Empirically supported therapies like CPT, EMDR, MI, and CBT can substantially improve his mental health and functional outcomes. Overcoming systemic barriers and fostering a supportive, recovery-oriented environment are essential to facilitate long-term recovery and enhanced quality of life for Angel.

References

• Brown, C., & Rapee, R. M. (2017). Advances in the treatment of generalized anxiety disorder: A systematic review of the evidence. Journal of Anxiety Disorders, 50, 42–55.
• Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (2010). Generalized anxiety disorder. In E. J. Sirri (Ed.), Cognitive-behavioral treatment of GAD: Advances in theory and practice (pp. 75–95). Springer.
• Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2012). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.
• Hofmann, S. G. (2014). Cognitive-behavioral therapy for anxiety and related disorders. Journal of Anxiety Disorders, 8(2), 90–96.
• Monti, P. M., et al. (2002). Motivational enhancement therapy for alcohol abuse. In R. W. Larimer & H. C. Whitton (Eds.), Evidence-based approaches for alcohol and drug abuse treatment (pp. 51–70). Springer.
• Najavits, L. M. (2015). Seeking Safety: A treatment manual for PTSD and substance abuse. Guilford Publications.
• Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD: A comprehensive manual. Guilford Publications.
• Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.
• McHugh, R. K., et al. (2019). Peer recovery coaching for substance use disorder: An evidence-based intervention. Journal of Substance Abuse Treatment, 97, 87–92.
• Smith, J. E., et al. (2016). Addressing barriers to mental health services: Strategies and interventions. Journal of Behavioral Health Services & Research, 43(4), 582–595.